Out-of-pocket expenditures for childbirth in the context of the Janani Suraksha Yojana (JSY) cash transfer program to promote facility births: who pays and how much? Studies from Madhya Pradesh, India

International Journal for Equity in Health

Research

Gaetano Marrone¹  Mariano Salazar¹  Kristi Sidney¹  Ayesha DeCosta²  Vishal Diwan³  Lars Lindholm⁴ 

[1] Department of Public Health Sciences, Karolinska Institutet, Widerströmska, Tomtebodavägen 18A, plan 4, SE-171 77, Stockholm, Sweden;Department of Public Health Sciences, Karolinska Institutet, Widerströmska, Tomtebodavägen 18A, plan 4, SE-171 77, Stockholm, Sweden;International Center for Health Research, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India;Department of Public Health Sciences, Karolinska Institutet, Widerströmska, Tomtebodavägen 18A, plan 4, SE-171 77, Stockholm, Sweden;Public Health and Environment, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India;International Center for Health Research, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India;Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;

关键词: Out-of-pocket expenditure;    Conditional cash transfer;    Maternal health;    Facility based delivery;    India;   

DOI  :  10.1186/s12939-016-0362-4

 received in 2016-02-26, accepted in 2016-04-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHigh out-of-pocket expenditures (OOPE) make delivery care difficult to access for a large proportion of India’s population. Given that home deliveries increase the risk of maternal mortality, in 2005 the Indian Government implemented the Janani Suraksha Yojana (JSY) program to incentivize poor women to deliver in public health facilities by providing a cash transfer upon discharge. We study the OOPE among JSY beneficiaries and women who deliver at home, and predictors of OOPE in two districts of Madhya Pradesh.MethodsSeptember 2013 to April 2015 a cross-sectional community-based survey was performed. All recently delivered women were interviewed to elicit delivery costs, socio-demographic characteristics and delivery related information.ResultsMost women (n = 1995, 84 %) delivered in JSY public health facility, the remaining 16 % (n = 386) delivered at home. Women who delivered under JSY program had a higher median, IQR OOPE ($8, 3–18) compared to home ($6, 2–13). Among JSY beneficiaries, poorest women had twice net gain ($20) versus wealthiest ($10) post cash transfer. Informal payments (64 %) and food/baby items (77 %) were the two most common sources of OOPE. OOPE made among JSY beneficiaries was pro-poor: poorer women made proportionally less expenditures compared to wealthier women. In an adjusted model, delivering in a JSY public facility increased odds of incurring expenditures (OR: 1.58, 95 % CI: 1.11–2.25) but at the same time to a 16 % (95 % CI: 0.73–0.96) decrease in the amount paid compared to home deliveries.ConclusionsOOPE is prevalent among JSY beneficiaries as well in home deliveries. In JSY, OOPE varies by income quintile: wealthier quintiles pay more OOPE. However the cash incentive is adequate enough to provide a net gain for all quintiles. OOPE was largely due to indirect costs and not direct medical payments. The program seems to be effective in providing financial protection for the most vulnerable groups.

【 授权许可】

CC BY   
© Sidney et al. 2016